implants - international magazine of oral implantology

I overview Fig. 1_Example of an osteotome. Fig. 2_Bone expansion (splitting) by osteotome. Fig. 3_Bone density via osteotome. Fig. 4_Indirect sinus lift according to Summers‘ osteotome technique. Fig. 5_Indirect sinus lift according to Summers‘ augmentation and implant insertion. _Introduction In the early days of implant dentistry, the main objective was to achieve a good stability for remov- abledentures.However,therangeofindicationshas changed quickly. Today, patients are treated al- though they have thin crestal bone or a poor bone quality. Poor bone quality is found in the categories D3 and D4 (according to Carl E. Misch, Table 1). In contrast to the lower anterior region, which often corresponds to category D1, categories D3 and D4 arefoundmainlyintheposteriormaxilla,butalsoin the premaxilla (Table 1, green marks). _Materials and methods Bone of the qualities D3 or D4 can be improved and is thus made available for dental implantation. Osteotomes (Fig. 1) of different shapes were devel- oped to help enhance bone density. They compress the cancellous bone and thus provide good primary stability of an endosseous implant (Fig. 2). This way, the bone quality can be improved by one category. The primary stability is a “sine qua non” and nec- essary for a strong bone-implant bond (osseointe- gration). Further applications of specially modified osteotomes are splitting or bone spreading in cases of single-tooth implantation (Fig. 3). Additionally, osteotomes can be used in indirect sinus lift proce- dures (Figs. 4 and 5). Note that the implant screw shown in Figure 5 is a sample drawing (source: Impla, Schütz Dental GmbH). Allmethodsusingosteotomesdependontheini- tial drilling of a pilot hole with a minimal diameter (2 mm). Drilling the pilot hole always goes along with a loss of bone mass, which only rarely is avail- able in abundance. For this reason, hollow os- teotomes have been developed, which combine the advantages of conventional osteotomes with the simultaneous removal of bone at the implant site. Additionalbonecanalsobeharvestedeasilyviahol- lowosteotome(Figs.6a-c)inotherappropriatesec- tions of the jaw. Theauthorshavealreadypublishedthisboneex- traction technique with a bone trephine drill. In this way, a circular hole is drilled into the jaw bone. A bone cylinder is stuck inside the drill or remains in thejaw.Asaresult,acylindricalpieceofbonecanbe removed for later use, e.g. as autogenous augmen- tationmaterial. Thedesignofthetrephinedrill(Figs. 7aandb)requiresarelativelysolidwallthickness,so only a bone cylinder which is relatively small when comparedtotheouterdiameterofthetrephinedrill can be applied. Furthermore, there are disadvan- tagesandsubstantialdifficultiesinpositioningthat Applications of hollow osteotomes in dental implantology Authors_Dr Rolf Vollmer, Dr Mazen Tamimi, Dr Rainer Valentin, Dr Suheil Boutros & Dr Martina Vollmer, Germany 24 I implants1_2013 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5